{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T14:06:56Z","timestamp":1772374016277,"version":"3.50.1"},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2014,1,10]],"date-time":"2014-01-10T00:00:00Z","timestamp":1389312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,4]]},"abstract":"Objective<\/jats:title>To ascertain if a predictor of obstructed labour and obstetric fistula (OF<\/jats:styled-content>) occurrence could be devised.<\/jats:p><\/jats:sec>Design<\/jats:title>Observational study of two cohorts.<\/jats:p><\/jats:sec>Setting<\/jats:title>Selian L<\/jats:styled-content>utheran M<\/jats:styled-content>ission H<\/jats:styled-content>ospital, A<\/jats:styled-content>rusha, T<\/jats:styled-content>anzania and A<\/jats:styled-content>berdeen W<\/jats:styled-content>omen's C<\/jats:styled-content>entre, F<\/jats:styled-content>reetown, S<\/jats:styled-content>ierra L<\/jats:styled-content>eone.<\/jats:p><\/jats:sec>Population<\/jats:title>All women presenting with OF<\/jats:styled-content> caused by obstructed labour and all women having a normal vaginal delivery (NVD<\/jats:styled-content>) at both institutions were eligible for the study.<\/jats:p><\/jats:sec>Methods<\/jats:title>All women with OF<\/jats:styled-content> and those delivering normally had their height in centimetres measured and their intertuberous space measured by the number of examiner's knuckles admitted. The dimensions for OF<\/jats:styled-content> and normal delivery were examined individually and multiplied to gain a \u2018fistula index\u2019.<\/jats:p><\/jats:sec>Main outcomes measures<\/jats:title>Dimensions and index were compared statistically between OF<\/jats:styled-content> and NVD<\/jats:styled-content> women using t<\/jats:italic> tests. Sensitivity, specificity and predictive values from receiver operating characteristic curves were obtained for predicting OF<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>There were statistical differences between the groups with OF<\/jats:styled-content> women being significantly shorter, having a smaller intertuberous space and lower fistula index than those undergoing NVD<\/jats:styled-content> (each P\u00a0<\/jats:italic><\u00a00.001). Sensitivity was high for fistula index\u00a0\u2264\u00a0507.5 (94.9%, 95% confidence interval 83.1\u201398.6%) and for intertuberous space of at least three knuckles (92.3%, 95% CI<\/jats:styled-content> 79.7\u201397.3%) alone.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>A simple antenatal measurement of intertuberous space could screen those women at higher risk of needing medical intervention to prevent OF<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12527","type":"journal-article","created":{"date-parts":[[2014,1,10]],"date-time":"2014-01-10T06:25:05Z","timestamp":1389335105000},"page":"604-609","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Predicting women at risk for developing obstetric fistula: a fistula index? An observational study comparison of two cohorts"],"prefix":"10.1111","volume":"121","author":[{"given":"A","family":"Browning","sequence":"first","affiliation":[{"name":"Selian Fistula Project Arusha Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Lewis","sequence":"additional","affiliation":[{"name":"Aberdeen Women's Centre Freetown Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Whiteside","sequence":"additional","affiliation":[{"name":"Medical Statistics University of Manchester Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,1,10]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development","author":"Lewis G","year":"2006"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.2307\/172248"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.02.007"},{"key":"e_1_2_7_5_1","first-page":"58","article-title":"Genital fistula","volume":"25","author":"Bhasker Rao K","year":"1975","journal-title":"J Obstet Gynaecol Ind"},{"key":"e_1_2_7_6_1","first-page":"69","article-title":"The vesico\u2010vaginal and allied fistulae\u2014a report on 40 cases","volume":"9","author":"Bal JS","year":"1975","journal-title":"Med J Zambia"},{"key":"e_1_2_7_7_1","first-page":"213","article-title":"Fistules recto\u2010vaginales d'origine obstetricale","volume":"30","author":"Docquier J","year":"1983","journal-title":"Med d'Afr Noire"},{"key":"e_1_2_7_8_1","first-page":"98","article-title":"Epidemiology of vesico\u2010vaginal fistulae in northern Nigeria","volume":"9","author":"Ampofo K","year":"1990","journal-title":"West Afr J Med"},{"key":"e_1_2_7_9_1","volume-title":"Statistics with Confidence","author":"Altman D","year":"2000"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-008-0736-2"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2271011658"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(91)90671-Q"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2000.tb10394.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(88)90107-5"}],"container-title":["BJOG: An International Journal of Obstetrics & Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1471-0528.12527","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.12527","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T00:01:33Z","timestamp":1695513693000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.12527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,1,10]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,4]]}},"alternative-id":["10.1111\/1471-0528.12527"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.12527","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1,10]]},"assertion":[{"value":"2013-10-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-01-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}